Effects of marketing claims on toddler food products on parents' product preferences, perceptions and purchasing intentions: an online experiment.

BACKGROUND: The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents' responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. METHODS: Parents of toddlers aged 12 to < 36 months (N = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains "good" ingredient'; 'free from "bad" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. RESULTS: For the overall sample, brief exposure to 'free from "bad" ingredient' claims increased participant's intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that 'contains "good" ingredient' claims and 'child-related' claims significantly impacted parent's preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed 'contains "good" ingredient' or 'free from "bad" ingredient' claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. CONCLUSIONS: Findings indicate that 'free from "bad" ingredient' claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. 'Contains "good" ingredient' claims and 'child-related' claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children's diets and health.

Developmental and adaptive functioning of very young children with solid tumors and brain tumors.

PURPOSE: Infancy/toddlerhood is a period of rapid development. All infants/toddlers (0-36 months-of-age) undergoing cancer-directed treatment at one hospital are offered developmental assessments and related services. Yet, literature comparing development of infants/toddlers with brain tumors to those with non-CNS solid tumors is sparse. DESIGN AND METHODS: Developmental assessment data were abstracted from electronic health records of infants/toddlers undergoing treatment for a brain tumor (n = 36; mean age = 21.83 ± 9.96 months) or a solid tumor (n = 40; mean age = 17.35 ± 8.50). Z-scores compared obtained data with age expectations. Chi-square analyses assessed whether a greater proportion of participants scored within the clinical range than normative expectations. Multivariate analysis of variance and chi-square analyses compared developmental outcomes between groups. RESULTS: Compared with age expectations, the overall group demonstrated significantly less well-developed skills. Infants/toddlers with solid tumors demonstrated clinical deficits at rates higher than expected for most domains; the rate of impairment for the solid tumor group did not differ significantly from that of the brain tumor group across most subtests. CONCLUSIONS: Like young patients with brain tumors, the developmental functioning of infants/toddlers with solid tumors should be studied across time to determine the trajectory of functioning for these young patients and to inform future developmental intervention studies. PRACTICE IMPLICATIONS: Infants/toddlers with a malignant solid tumor may be at increased risk for delayed development. These very young patients would likely benefit from developmental assessment, early intervention services during and after treatment, and ongoing monitoring of development across time.

Infant-directed speech facilitates word learning through attentional mechanisms: An fNIRS study of toddlers.

The speech register that adults especially caregivers use when interacting with infants and toddlers, that is, infant-directed speech (IDS) or baby talk, has been reported to facilitate language development throughout the early years. However, the neural mechanisms as well as why IDS results in such a developmental faciliatory effect remain to be investigated. The current study uses functional near-infrared spectroscopy (fNIRS) to evaluate two alternative hypotheses of such a facilitative effect, that IDS serves to enhance linguistic contrastiveness or to attract the child's attention. Behavioral and fNIRS data were acquired from twenty-seven Cantonese-learning toddlers 15-20 months of age when their parents spoke to them in either an IDS or adult-directed speech (ADS) register in a naturalistic task in which the child learned four disyllabic pseudowords. fNIRS results showed significantly greater neural responses to IDS than ADS register in the left dorsolateral prefrontal cortex (L-dlPFC), but opposite response patterns in the bilateral inferior frontal gyrus (IFG). The differences in fNIRS responses to IDS and to ADS in the L-dlPFC and the left parietal cortex (L-PC) showed significantly positive correlations with the differences in the behavioral word-learning performance of toddlers. The same fNIRS measures in the L-dlPFC and right PC (R-PC) of toddlers were significantly correlated with pitch range differences of parents between the two speech conditions. Together, our results suggest that the dynamic prosody in IDS increased toddlers' attention through greater involvement of the left frontoparietal network that facilitated word learning, compared to ADS. RESEARCH HIGHLIGHTS: This study for the first time examined the neural mechanisms of how infant-directed speech (IDS) facilitates word learning in toddlers. Using fNIRS, we identified the cortical regions that were directly involved in IDS processing. Our results suggest that IDS facilitates word learning by engaging a right-lateralized prosody processing and top-down attentional mechanisms in the left frontoparietal networks. The language network including the inferior frontal gyrus and temporal cortex was not directly involved in IDS processing to support word learning.

Neurodevelopmental profile of infants and toddlers awaiting a kidney transplant.

BACKGROUND: Infants and toddlers with kidney failure are susceptible to neurodevelopmental delays due to medical comorbidities and rapid brain development in early childhood. However, research on the neuropsychological development of this patient population has been limited over the past 10 years. METHODS: We performed a retrospective study to evaluate the neurodevelopmental functioning of infants/toddlers with kidney failure who completed the Bayley Scales of Infant and Toddler Development (3rd and 4th Edition) as part of a pretransplant evaluation between 2010 and 2022 (n = 23; Mage = 18 months, SD = 8.53; 16 males) using t-tests, linear model, and Pearson correlations. RESULTS: Mean Bayley scores of participants were below normative means for cognition (M = 86.74, 95% CI = 80.53-92.94, p < 0.001), language (M = 79.20, 95% CI = 73.32-85.08, p < 0.001), and motor (M = 78.00, 95% CI = 70.15-85.85, p < 0.001) domains. After adjusting for prematurity and epilepsy, patients on dialysis had significantly lower cognitive (78.7 vs. 93.8; p = 0.001) and motor scores (67.1 vs. 85.5; p = 0.01) compared to no dialysis. Pretransplant cognitive scores were positively correlated with posttransplant Full-Scale IQ (r(8) = 0.65 p = 0.04), verbal comprehension (r(8) = 0.75 p = 0.02), and fluid reasoning (r(7) = 0.68 p = 0.045). Similarly, pretransplant language scores were positively correlated with posttransplant Full-Scale IQ (r(7) = 0.74 p = 0.03) and verbal comprehension (r(7) = 0.73 p = 0.03). Of the 16 participants who reached age > 5 years during the study period, seven were diagnosed with a neurodevelopmental disorder, including three with autism spectrum disorder. CONCLUSIONS: Infants and toddlers with kidney failure are at risk of developmental delays and later neurodevelopmental disorders. Dialysis is associated with cognitive and motor delays independent of prematurity and epilepsy.

Growth Patterns of 11-29-Month-Old Children Consuming Young Child Formula: Secondary Analysis of a Randomized, Controlled Study.

INTRODUCTION: The impact of young child formula (YCF) consumption on children's growth, particularly under suboptimal conditions, has scarcely been studied. In the current study, weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BAZ) z-score development was evaluated in children from five different countries (n = 668) who participated in a double-blind, randomized, controlled trial. METHODS: The children (1-3 years old) were randomized to one of two intervention YCFs (with presence or absence of prebiotics and n-3 LCPUFAs) during 52 weeks of intervention. Additional stratified analyses evaluated the growth patterns of underweight, overweight, or stunted children. RESULTS: No apparent differences in anthropometric measurements were observed between the intervention groups. In both YCF intervention groups, mean WAZ, LAZ and BAZ development was indicative of adequate growth during the intervention period. Stratified analyses showed stable WAZ and BAZ development among children with a healthy weight or overweight at baseline. Among underweight and stunted children, normalization in mean weight (∼1 SD) and length (∼0.8 SD) gain, respectively, was observed. CONCLUSION: The current study suggests that consumption of YCF, either or not containing prebiotics and n-3 LCPUFAs, is associated with adequate growth among young children. This association may depend on the child's baseline nutritional status. Future studies to assess the potential role of YCF in supporting adequate weight/length gain among children at risk for undernutrition are warranted.

Relationship of nutritional behaviors and parent-child interactions with developmental domains of Iranian toddlers: a cross-sectional study.

BACKGROUND: Health service providers closely monitor the developmental state of toddlers to identify the factors affecting this process because any defect during this period will cause irreversible damage. Therefore, this study investigated the relationship of nutritional behaviors and parent-child interactions with the developmental domains of Iranian toddlers. METHODS: This cross-sectional, descriptive-analytical study was conducted on 341 toddlers aged 12-36 months covered by comprehensive health centers in the south of Tehran in 2021-2022. The participants were selected through single-stage cluster sampling. To this end, 16 comprehensive health centers were randomly selected, and then some of the clients from each center were randomly selected as the sample. The required data were collected through the Ages and Stages Questionnaire (ASQ), the Children's Eating Behavior Questionnaire (CEBQ), the Child-Parent Relationship Scale (CPRS), and a demographics form. They were then analyzed statistically using descriptive and inferential statistics in SPSS-21, considering a significance level of p < 0.05. RESULTS: The results showed that most participants were normal in all developmental domains (communication, gross motor, fine motor, personal-social, and problem-solving), with a mean developmental delay ranging from 1.8 to 7%. The most serious problem of participants requiring medical referral was related to gross motor (7%) with a mean of 54.35 ± 7.28 followed by communication (6.5%) with a mean of 49.41 ± 9.67. The mean nutritional behavior of participants was 77.9 ± 21.7. A significant relationship was found between the nutritional behaviors of participants and the problem-solving domain of development (p = 0.018). The results also indicated a mean parent-child interaction score of 94.26 ± 12.63. There was a significant relationship between parent-child interactions and the communication area of development (p = 0.04). CONCLUSION: Since some areas of toddler development are influenced by children's nutritional behavior and parent-child interactions, it is necessary to train families to identify, monitor, and correct the factors affecting the development of their children. Health system officials and planners are also recommended to develop interventions to improve the nutritional behaviors of children and parent-child interactions.

A case-control study of the risk factors for fistula-in-ano in infants and toddlers.

BACKGROUND: Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives. OBJECTIVES: The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies. DESIGN AND SETTINGS: A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021. INDEPENDENT VARIABLES: (a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors. RESULTS: Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089). CONCLUSION: Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Sleep initiation patterns and sleep quality among toddlers in the southeast of China: initial study results.

BACKGROUND: A large number of psychological consequences including sleep health emerged during the 2019 Coronavirus disease (COVID-19) pandemic. Sleep patterns in toddlers are vulnerable to negative environmental exposures, however, very few studies on this topic have been published so far. OBJECTIVES: In this paper, we aimed to investigate the sleep patterns and associated factors in toddlers from China confined at home in the context of COVID-19 pandemic. METHODS: From April to November 2021, a convenience sample of 493 parents of young children aged (12-35 months) were surveyed from Fuzhou, Sanming, Quanzhou, Nanping, and Longyan cities in the Fujian Province, China. A cross-sectional survey was conducted via Electronic questionnaires to collect parent and child social-demographic characteristics. The Brief Infant Sleep Questionnaire (BISQ) was used to collect data on sleep practices, sleep duration and patterns, as well as the number of nocturnal awaking . RESULTS: The mean age of toddlers was 2.11 years old, and 52.54% (259/493) were males. Among the 493 toddlers' sleep patterns, 331(67.1%) initiated sleep accompanied by parents, 67(13.6%) slept independently, 59 (12.0%) were breast fed/bottle fed to initiate sleep, 27 (5.5%) were held and 9 (1.8%) rocked. The clear longitudinal association between the duration of night-time sleep, the frequency of nighttime awakenings, and various sleep patterns remains clear (p < 0.05). Multiple linear regression analysis indicated that sleep initiation with bottle-feeding/breast-feeding and rocked significantly increased the frequency of nighttime awakenings and reduced the duration of nighttime sleep (p < 0.05), as held was dramatically only for increasing the number of nighttime awakenings (p < 0.05). Multi-variate logistic regression analysis demonstrated that toddlers with severe sleep difficulties had a higher probability of being rocked to initiate sleep (p < 0.05). Conversely, young children with minor sleep problems were more apt to be in bed alone to initiate sleep (p < 0.05). CONCLUSIONS: During the COVID-19 pandemic, most infants and toddlers initiated sleep accompanied by parents and tend to have electronic media exposure before bedtime. Increased waking at night may be associated with sleep initiation with breast-feeding/bottle-feeding. Therefore, pediatric practitioners in primary community hospitals should pay attention to the education and promotion of sleep hygiene and parenting knowledge of young children to avoid the formation of poor sleep hygiene habits.

Feasibility and safety of stereoelectroencephalography in young children.

PURPOSE: Stereoelectroencephalography (SEEG) is a diagnostic surgery that implants electrodes to identify areas of epileptic onset in patients with drug-resistant epilepsy (DRE). SEEG is effective in identifying the epileptic zone; however, placement of electrodes in very young children has been considered contraindicated due to skull thinness. The goal of this study was to evaluate if SEEG is safe and accurate in young children with thin skulls. METHODS: Four children under the age of two years old with DRE underwent SEEG to locate the region of seizure onset. Presurgical planning and placement of electrodes were performed using ROSA One Brain. Preoperative electrode plans were merged with postoperative CT scans to determine accuracy. Euclidean distance between the planned and actual trajectories was calculated using a 3D coordinate system at both the entry and target points for each electrode. RESULTS: Sixty-three electrodes were placed among four patients. Mean skull thickness at electrode entry sites was 2.34 mm. The mean difference between the planned and actual entry points was 1.12 mm, and the mean difference between the planned and actual target points was 1.73 mm. No significant correlation was observed between planned and actual target points and skull thickness (Pearson R = - 0.170). No perioperative or postoperative complications were observed. CONCLUSIONS: This study demonstrates that SEEG can be safe and accurate in children under two years of age despite thin skulls. SEEG should be considered for young children with DRE, and age and skull thickness are not definite contraindications to the surgery.

Food fussiness is associated with family environmental factors in 1-3-year-old children: A large-scale cross-sectional study.

The effects of environmental factors on eating behavior and food intake are not well-known during toddlerhood. This is a cross-sectional study exploring the association between family environmental factors, food fussiness and poorly diversified diet. N = 1679 healthy children aged 1-3 years were recruited by general practitioners and pediatricians. Two validated questionnaires were used: the Children's Eating Behavior Questionnaire (CEBQ), which includes a food fussiness (FF) dimension, and the Infant and Child Feeding Index (ICFI) which assesses diet diversification. Factors associated with FF and diet diversification were identified by multivariate logistic regression. Of the 1356 analyzed children, 19.5% were fussy (CEBQ-FF subscore >3). Food fussiness was significantly more common in older children (25.1% of 2-3-year-olds, versus 15.2% of 1-2-year-olds; OR = 1.7) and those conceived with medical assistance (OR = 3.2). Food fussiness was also observed more often in children exposed to distractions during meals (OR = 1.8), rewarded by parents to finish meals (OR = 3.9), free to eat at will (OR = 3.7), or who ate only occasionally with the whole family (OR = 2.0). Unsatisfactory dietary diversification (ICFI≤13.8) was observed in 21.8% of children and was not significantly associated with any variable. No association was found between eating behavior and dietary diversification level. This study showed that food mistrust tends to increase with age in 1-3-year-old children. It highlighted the influence of environmental factors on FF, including family habits during meals. Assisting parents with child food fussiness may help reduce later unhealthy dietary patterns.

Parental Perceptions of Physical Activity and Risk of Disease Associated with Sedentary Behaviours in Infants and Toddlers.

OBJECTIVES: The current study intends to measure parents' perceptions of newborn and toddler physical activity. METHODS: A Cross-sectional study was conducted at the pediatric clinic at a University Hospital in Riyadh. The parents or guardians of children 0 to 3 years of age, healthy infants, and toddlers who visited the vaccination and pediatric clinic at a University Hospital in Riyadh, were recruited. The Parental Perceptions of Physical Activity Scale (PPPAS) was translated into the Arabic language. The Chi-square test was applied to observe the association between categorical variables. P value < 0.05 was considered to be statistically significant. RESULTS: A total of 383 parents were recruited. There was a significant association observed between physical activity and income, employment, and education. A significant association was observed between the following perceptions; the child enjoys physical activity, it increases the child's fitness level, the strength of the muscles, flexibility, and life span, improves happiness, keeps the child active, and provides a sense of achievement, and decrease future weight problems. CONCLUSION FOR PRACTICE: The study determined that parental inclination towards engaging in a physical activity intervention for their infants, as well as identifying any concerns that may impact their children's adherence to physical activity was satisfied.

What is already known on this subject? Youth health is crucial since cardiovascular disease and obesity are linked to sedentary behaviors in children and will persist into adulthood.What this study adds? The study addresses the concerns of parents regarding physical activities which is an emerging concern for children's health. It investigates the viewpoint of parents about physical activities and the risk of diseases that may develop due to sedentary behaviors among infants and toddlers.

Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study.

BACKGROUND: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. OBJECTIVE: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. METHODS: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. RESULTS: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). CONCLUSIONS: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.

Interventions to improve executive functions in children aged 3 years and under: A systematic review.

BACKGROUND: Early executive functioning (EF) skills are foundational capabilities that predict school readiness, academic development and psychiatric risk. Early interventions enhancing these capabilities could have critical import in improving outcomes. However, to develop interventions, it is necessary to identify specific EF skills that will vary with child age. Thus, we aimed to examine the characteristics and efficacy of interventions targeting EF in infancy and early childhood up to age 3. METHODS: A comprehensive search of PubMed, Embase, CINAHL and APA PsycINFO databases was performed for studies published before December 2022. Randomized and non-randomized studies of interventions designed to improve at least one EF skill in children ≤3 years were included. EF skills included attentional control, inhibition/self-regulation, activity initiation, working memory, cognitive flexibility, planning ability, problem-solving and performance monitoring. We independently extracted data, used the revised Cochrane Risk-of-Bias tool to assess the quality of the evidence and conducted Synthesis Without Meta-analysis (SWiM). The overall quality of the evidence and the strength of recommendations was determined using elements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Thirty-five studies met inclusion criteria (original n = 7467). Studies were highly variable in the EF skill targeted, target subject (i.e., child, parent and teacher), nature and dosage of the intervention, and timing of outcome assessment. Most interventions focused on improving impulse control and self-regulation. The overall quality of evidence was low to moderate with a high risk of bias, though six studies had low risk of bias but yielded mixed findings of efficacy. CONCLUSIONS: The relatively small number of early EF intervention studies uses such variable methods that there is currently no converging evidence of efficacy to recommend a specific intervention. Thus, findings support the need for a more systematic, targeted approach to the design and implementation of early EF interventions for target populations.

Early Mother-Child Interaction Flexibility Predicts Adolescent Psychological Adjustment.

Although greater mother-child interaction flexibility has been linked with overall better adjustment within early childhood and adolescence, whether this link persists across the two developmental periods remains unknown. This longitudinal study examined mother-toddler flexibility in affective and behavioral exchanges as predictors of adolescents' externalizing and internalizing symptoms. Sample included 128 families with their 33-month-old toddlers (52% female), of whom 67 returned in adolescence (M age = 13.25 years, SD = 0.59). Greater affective flexibility during play and behavioral flexibility during snack predicted fewer parent-reported externalizing (but not internalizing) symptoms ten years later, controlling for the positivity-negativity of mother-toddler interactions, early-childhood adjustment, and mother-adolescent flexibility. The findings highlight the unique, prospective role of early-life caregiving flexibility in mitigating adolescents' behavioral problems.

Transitioning to a Plant-Based Menu in Childcare: Identifying the Nutritional, Financial, and Logistical Considerations.

International health organizations have called for a shift towards more plant-based foods as a way of promoting both individual health and environmental sustainability. Given the high percentage of children in Canada who attend childcare and the high volume of food provided in childcare, transitioning menus to incorporate plant-based foods could have important implications for both planetary and child health. The purpose of this case study is to describe a childcare centre's transition to a plant-based menu. A detailed nutritional analysis of the menu was conducted. The financial and logistical implications of the transitions to a plant-based menu were also assessed. Nutritional analysis revealed that the plant-based menu met or exceeded the daily nutrient requirement for all the key nutrients explored. Financially, the transition led to a 9% reduction in food costs. Logistically, the transition led to improved efficiency and safety with regard to food preparation, with substantially fewer tailored meals due to allergies and dietary restrictions required after the transition. These novel findings are relevant for food service administrators interested in transitioning to a plant-based menu as well as public health dietitians who could support the transition.

Impact of talker variability on language development in two-year-olds.

This research investigated the impact of the number of talkers with whom children engage in daily conversation on their language development. Two surveys were conducted in 2020, targeting two-year-olds growing up in Japanese monolingual families. Caregivers reported the number of talkers in three age groups and children's productive vocabulary via questionnaires. The results demonstrated significant effects of variability in talkers in fifth grade or above in Study 1 (N = 50; male = 23; r = .372) and in adult talkers in Study 2 (N = 175; non-nursery going; male = 76; r = .184) on children's vocabulary development, after controlling for language exposure time and demographic variables. Possible mediating factors are discussed. This research extends previous findings from immigrant bilingual children to monolingual speakers in Japan, suggesting the potential contribution of available talkers other than caregivers in conversational environments.

Psychometric properties of the French Infant-Toddler Working Alliance Inventory Short version (IT-WAI-S).

OBJECTIVE: Therapeutic alliance has been little investigated in infant and toddler therapy, with no tools specifically adapted to this population. However, we have developed the Infant-Toddler Working Alliance Inventory-Short form (IT-WAI-S) which is based on the Working Alliance Inventory. The aim of this study was to assess the psychometric properties of this original French tool, in its two versions: for parent (IT-WAI-SP) and for therapist (IT-WAI-STh). METHOD: This study included 227 families consulting with their 18-48-month-old child for emotional or behavioral disorders. The scales were filled in at the first three therapy sessions. The IT-WAI-S acceptability, internal validity, reliability and predictive validity (association with child and mother's outcomes) were evaluated. RESULTS: Confirmatory then exploratory factor analyses revealed a three-factor structure for the both scales: Negative Experience of Care Relationship, Positive Alliance and Alliance with the Child. Acceptability, reproducibility and construct validity were satisfactory for both versions. The two versions predicted the child's outcome. The IT-WAI-SP predicted also the mother's outcome. The IT-WAI-STh gave more reproducible results, whereas the IT-WAI-SP was a better predictor of the child's progress. CONCLUSION: The two IT-WAI-S versions showed good psychometric properties and could be used to study the therapeutic alliance in young children.

Research on commercial milk formulas for young children: A scoping review.

A scoping review of publications about commercial milk formulas intended for or consumed by children 12-36 months (CMF 12-36) was conducted. This review aimed to comprehensively map the existing literature, identify key concepts in the field and understand its evolution through time. A total of 3329 articles were screened and 220 were included, published between 1986 and 2024. Most works were published after 2016 (70.0%) and in high-income countries (71.8%). Original studies were the vast majority (81.8%) of publications. Most publications dealt with feeding practices or analysed the composition and/or contamination of specific products (44.1% and 35.9%), but since the late 2000s, publications about marketing, policy, legislation, and consumer perception started to appear. Most published works (65.5%) did not focus exclusively on CMF 12-36 and included formulas for other demographics or other foods. About half of the works (55.5%) did not consider CMF 12-36 to be a breast milk substitute. We found 81 distinct product denominations used to refer to CMF 12-36, Growing Up Milk was the most common (25.9%). CMF industry was involved in 41.8% of all analysed works, and industry participation and funding were not always clearly informed (22.5% lacked a conflict of interest statement, and 25.5% did not present any information about funding). In the last decade, publications about CMF 12-36 have increased in volume and diversified in scope and subject matter. CMF-industry participation has always been and still is present in the field, so possible vested interests should be taken into account when appreciating the literature.

How to Achieve Highly Professional Care in the Postoperative Ward: The Care of Infants and Toddlers.

PURPOSE: The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia. DESIGN: A qualitative design with a critical incident approach. METHODS: Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis. FINDINGS: The main finding was the CCNs' and RNAs' description of how they "watch over the children and stay close" to provide emotional and physical safety. CCNs' and RNAs' experiences of observing and managing the children's small, immature airways were reflected in the theme "using situation awareness of the small, immature airways." The theme "understanding emergence agitation" describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme "having parents nearby" shows the necessity and value of involving parents in their children's care. CONCLUSIONS: Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one's behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children's small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.

An urgent appeal to paediatric primary caregivers to help prevent severe iron deficiency anemia in toddlers.

Iron deficiency anemia (IDA) is a common problem in toddlers. The cause of IDA is multifactorial but is often from excessive consumption of cow's milk. The prevalence and at times devastating consequences of IDA are under recognized. There are increasing numbers of toddlers presenting with severe IDA. We urge all paediatric primary care givers to help prevent severe IDA through adherence to the 2019 CPS Guidelines on iron requirements, early diagnosis, and adequate treatment.